Invasive Assessment of Coronary Artery Disease in Clonal Hematopoiesis of Indeterminate Potential.

BACKGROUND: Clonal hematopoiesis of indeterminate potential (CHIP) occurs due to acquired mutations in bone marrow progenitor cells. CHIP confers a 2-fold risk of atherosclerotic cardiovascular disease. However, there are limited data regarding specific cardiovascular phenotypes. The purpose of this study was to define the coronary artery disease phenotype of the CHIP population-based on coronary angiography. METHODS: We recruited 1142 patients from the Vanderbilt University Medical Center cardiac catheterization laboratory and performed DNA sequencing to determine CHIP status. Multivariable logistic regression models and proportional odds models were used to assess the association between CHIP status and angiography phenotypes. RESULTS: We found that 18.4% of patients undergoing coronary angiography had a CHIP mutation. Those with CHIP had a higher risk of having obstructive left main (odds ratio, 2.44 [95% CI, 1.40-4.27]; P=0.0018) and left anterior descending (odds ratio, 1.59 [1.12-2.24]; P=0.0092) coronary artery disease compared with non-CHIP carriers. We additionally found that a specific CHIP mutation, ten eleven translocase 2 (TET2), has a larger effect size on left main stenosis compared with other CHIP mutations. CONCLUSIONS: This is the first invasive assessment of coronary artery disease in CHIP and offers a description of a specific atherosclerotic phenotype in CHIP wherein there is an increased risk of obstructive left main and left anterior descending artery stenosis, especially among TET2 mutation carriers. This serves as a basis for understanding enhanced morbidity and mortality in CHIP.

Ultrasensitive electrochemical immunosensor for the detection of C-reactive protein antigen.

Cardiovascular disease is one of the leading causes of premature death worldwide, and the determination of C-reactive protein (CRP) from human serum is of vital importance for the diagnosis of the disease. For this study, we have developed an electrochemical immunosensor based on onion-like carbon@polyacrylonitrile (OLC-PAN) for the detection of CRP antigens. This was accomplished by immobilizing CRP antibodies on a modified glassy carbon electrode (GCE). Several electrochemical techniques such as cyclic voltammetry (CV), square wave voltammetry (SWV), and electrochemical impedance spectroscopy (EIS) were employed to evaluate the electrochemical detection of the CRP antigen. This ultrasensitive method for CRP antigen detection exhibited a very good logarithmic plot from -4.52 to -12.05 g mL-1 and a limit of detection (LOD) of 0.9 fg mL-1. The high selectivity, sensitivity, and stability of the developed electrochemical immunosensor would facilitate miniaturization for point-of-care applications and the efficient diagnosis of cardiovascular diseases.

A Pilot Study Using a Standardized Trauma Assessment Tool After Tactical Combat Casualty Care Course: A Comparison of the United States and Ghana.

INTRODUCTION: Assessment, monitoring, and evaluation have been a required part of Global Health Engagement but difficult to accomplish. The current assessment, monitoring, and evaluation frameworks require implementation at the start of the project and are not designed to use for already existing programs. Tactical Combat Casualty Care (TCCC) is a standardized course now offered in 89 countries, but there has not been a standardized method of evaluating the quality across programs. Ghana's TCCC program began in March 2022 and provides a platform for development of a new method of evaluation globally. METHODS: In this study, a standardized trauma scenario was performed by two groups of students, one who completed a TCCC Medical Provider course in Fort Detrick, MD and one who completed the course in Accra, Ghana. The students were scored using a standardized Trauma Assessment Score Sheet and the scores compared across the two groups. RESULTS: The mean Trauma Assessment Score was 58.5% in the United States and 58.3% in Ghana, with no statistically significant difference between the two groups (P-value of .97). When regressed for confounding variables such as years of experience and deployment, the two groups still had no statistically significant difference (P-value of .783). DISCUSSION: The two groups achieved similar mean scores despite significantly different testing environments and experience levels. Written post-test scores did not correlate well due to multiple confounding factors and appear to be a less accurate representation of student understanding and application than the Trauma Assessment Score. CONCLUSION: This study demonstrates use of a standardized scenario with graded checklist to compare between international programs. This can be used to and expanded to compare programs and support quality assurance and medical interoperability.

A glimpse into the future: modelling global prevalence of hypertension.

BACKGROUND: Hypertension is a major risk factor for cardiovascular diseases. Insights and foresights on trends of hypertension prevalence are crucial to informing health policymaking. We examined and projected the patterns of hypertension prevalence among sexes. METHODS: Using annual hypertension prevalence (18 + years) data sourced from WHO Global Health Observatory data repository from 1975 to 2015, Prophet models were developed to forecast the 2040 prevalence of hypertension in males, females, and both sexes. We used k-means clustering and self-organising maps to determine the clusters of hypertension prevalence concerning both sexes among 176 countries. RESULTS: Worldwide, Croatia is estimated to have the highest prevalence of hypertension in males by 2040, while that of females is in Niger. Among the world's most populated countries, Pakistan and India are likely to increase by 7.7% and 4.0% respectively in both sexes. South-East Asia is projected to experience the largest hypertension prevalence in males, whereas Africa is estimated to have the highest prevalence of hypertension in females. Low-income countries are projected to have the highest prevalence of hypertension in both sexes. By 2040, the prevalence of hypertension worldwide is expected to be higher in the male population than in female. Globally, the prevalence of hypertension is projected to decrease from 22.1% in 2015 to 20.3% (20.2 - 20.4%) in 2040. We also identified three patterns of hypertension prevalence in 2040, cluster one countries are estimated to have the highest prevalence of hypertension in males (29.6%, 22.2 - 41.1%) and females (29.6%, 19.4 - 38.7%). CONCLUSION: These findings emphasise the need for new and effective approaches toward the prevention and control of hypertension in Africa, South-East Asia, and Low-income countries.

Mechanical Exfoliation of Expanded Graphite to Graphene-Based Materials and Modification with Palladium Nanoparticles for Hydrogen Storage.

Hydrogen is a promising green fuel carrier that can replace fossil fuels; however, its storage is still a challenge. Carbon-based materials with metal catalysts have recently been the focus of research for solid-state hydrogen storage due to their efficacy and low cost. Here, we report on the exfoliation of expanded graphite (EG) through high shear mixing and probe tip sonication methods to form graphene-based nanomaterial ShEG and sEG, respectively. The exfoliation processes were optimized based on electrochemical capacitance measurements. The exfoliated EG was further functionalized with palladium nanoparticles (Pd-NP) for solid-state hydrogen storage. The prepared graphene-based nanomaterials (ShEG and sEG) and the nanocomposites (Pd-ShEG and Pd-sEG) were characterized with various traditional techniques (e.g., SEM, TEM, EDX, XPS, Raman, XRD) and the advanced high-resolution pair distribution function (HRPDF) analysis. Electrochemical hydrogen uptake and release (QH) were measured, showing that the sEG decorated with Pd-NP (Pd-sEG, 31.05 mC cm-2) and ShEG with Pd-NP (Pd-ShEG, 24.54 mC cm-2) had a notable improvement over Pd-NP (9.87 mC cm-2) and the composite of Pd-EG (14.7 mC cm-2). QH showed a strong linear relationship with an effective surface area to volume ratio, indicating nanoparticle size as a determining factor for hydrogen uptake and release. This work is a promising step toward the design of the high-performance solid-state hydrogen storage devices through mechanical exfoliation of the substrate EG to control nanoparticle size and dispersion.

Sustainable Tactical Combat Casualty Care Implementation in Ghana: A Model for Future Development.

INTRODUCTION: Department of Defense policy for Global Health Engagement (GHE) activities prioritizes interoperability and sustainability within security cooperation, yet these elements, along with monitoring and evaluation, are not well reported. MATERIALS AND METHODS: In this case study reviewing 1 year after the implementation of a Tactical Combat Casualty Care (TCCC) program in Ghana, the Ghana Armed Forces (GAF) has conducted five independent TCCC Medical Provider Tier courses and four All Service Member Tier courses. They have certified 240 students, 21 instructors, and appointed 2 affiliate faculty members with the National Association of Emergency Medical Technicians (NAEMT). Ghana is one of the only four active NAEMT-certified TCCC training sites in Africa. The principles that allowed for this achievement could serve as a 'best practice' model for GHE. RESULTS: Principally, the GAF took ownership of the program from the onset. The program also had an extensive preparatory phase 0 before initiating phase 1 on the ground training, which included establishing leadership and a medical modeling and simulation center pre-engagement. The triple partnership achieved between the U.S. DoD's African Peacekeeping Rapid Response Partnership, the GAF, and the NAEMT, a civilian certifying organization, allowed the sustainment of the TCCC program. African Peacekeeping Rapid Response Partnership also built on experience from other programs to develop a multifaceted model. Persisting challenges to the current program and future GHEs include continued funding and equipment, the associated issues with rapid expansion, and monitoring and evaluation, which all pose barriers to continued sustainment. CONCLUSION: The year sustainment of the GAF TCCC training program provides hope as a model for future DoD GHEs to attain sustainable development and points to the possibility of long-term programs with meaningful outcomes.

Enabling nature-based solutions: Innovating urban climate resilience.

Current conceptualizations of nature-based solutions have so far served to characterize-and reproduce-cost-effective remedies, particularly in cities of the global north. Yet nature-based solutions (NbS) are fundamental to the production of urban resilience. Focusing on Ghana's second largest city, Kumasi, this research (i) examines climate literacy and explores the existing nature-based solutions towards climate change adaption; (ii) examines the perception on existing NbS and the barriers to building climate resilience via NbS; and (iii) explores ways of promoting the implementation of NbS to build climate resilience. It addresses these objectives drawing from secondary data, 367 household surveys and 7 agency interviews. The findings show that about two thirds (63%) of urban residents in the case study area are climate illiterate, and this has affected the slow uptake of nature based solutions as climate management intervention. The urban residents acknowledge the importance of nature based solutions but identify barriers such as poor consideration of the role of natural infrastructure and their incorporation in the planning process, inadequate technical capacity and guidance for incorporating NbS in climate planning, high cost requirements of NbS interventions, disparate interests from various institutions, and a general lack of knowledge, appreciation and interest from urban residents. The study concludes that mainstreaming and upscaling NbS in urban systems will require major investments which should vary from one city to the other depending on perculiar needs.

Probing predilection to Crohn's disease and Crohn's disease flares: A crowd-sourced bioinformatics approach.

Background: Crohn's Disease (CD) is an inflammatory disease of the gastrointestinal tract that affects millions of patients. While great strides have been made in treatment, namely in biologic therapy such as anti-TNF drugs, CD remains a significant health burden. Method: We conducted two meta-analyses using our STARGEO platform to tag samples from Gene Expression Omnibus. One analysis compares inactive colonic biopsies from CD patients to colonic biopsies from healthy patients as a control and the other compares colonic biopsies from active CD lesions to inactive lesions. Separate tags were created to tag colonic samples from inflamed biopsies (total of 65 samples) and quiescent tissue in CD patients (total of 39 samples), and healthy tissue from non-CD patients (total of 30 samples). Results from the two meta-analyses were analyzed using Ingenuity Pathway Analysis. Results: For the inactive CD vs healthy tissue analysis, we noted FXR/RXR and LXR/RXR activation, superpathway of citrulline metabolism, and atherosclerosis signaling as top canonical pathways. The top upstream regulators include genes implicated in innate immunity, such as TLR3 and HNRNPA2B1, and sterol regulation through SREBF2. In addition, the sterol regulator SREBF2, lipid metabolism was the top disease network identified in IPA (Fig. 1). Top upregulated genes hold implications in innate immunity (DUOX2, REG1A/1B/3A) and cellular transport and absorption (ABCG5, NPC1L1, FOLH1, and SLC6A14). Top downregulated genes largely held roles in cell adhesion and integrity, including claudin 8, PAQR5, and PRKACB.For the active vs inactive CD analysis, we found immune cell adhesion and diapedesis, hepatic fibrosis/hepatic stellate cell activation, LPS/IL-1 inhibition of RXR function, and atherosclerosis as top canonical pathways. Top upstream regulators included inflammatory mediators LPS, TNF, IL1B, and TGFB1. Top upregulated genes function in the immune response such as IL6, CXCL1, CXCR2, MMP1/7/12, and PTGS2. Downregulated genes dealt with cellular metabolism and transport such as CPO, RBP2, G6PC, PCK1, GSTA1, and MEP1B. Conclusion: Our results build off established and recently described research in the field of CD. We demonstrate the use of our user-friendly platform, STARGEO, in investigating disease and finding therapeutic avenues.

Dissecting novel mechanisms of hepatitis B virus related hepatocellular carcinoma using meta-analysis of public data.

BACKGROUND: Hepatitis B virus (HBV) is a cause of hepatocellular carcinoma (HCC). Interestingly, this process is not necessarily mediated through cirrhosis and may in fact involve oncogenic processes. Prior studies have suggested specific oncogenic gene expression pathways were affected by viral regulatory proteins. Thus, identifying these genes and associated pathways could highlight predictive factors for HCC transformation and has implications in early diagnosis and treatment. AIM: To elucidate HBV oncogenesis in HCC and identify potential therapeutic targets. METHODS: We employed our Search, Tag, Analyze, Resource platform to conduct a meta-analysis of public data from National Center for Biotechnology Information's Gene Expression Omnibus. We performed meta-analysis consisting of 155 tumor samples compared against 185 adjacent non-tumor samples and analyzed results with ingenuity pathway analysis. RESULTS: Our analysis revealed liver X receptors/retinoid X receptor (RXR) activation and farnesoid X receptor/RXR activation as top canonical pathways amongst others. Top upstream regulators identified included the Ras family gene rab-like protein 6 (RABL6). The role of RABL6 in oncogenesis is beginning to unfold but its specific role in HBV-related HCC remains undefined. Our causal analysis suggests RABL6 mediates pathogenesis of HBV-related HCC through promotion of genes related to cell division, epigenetic regulation, and Akt signaling. We conducted survival analysis that demonstrated increased mortality with higher RABL6 expression. Additionally, homeobox A10 (HOXA10) was a top upstream regulator and was strongly upregulated in our analysis. HOXA10 has recently been demonstrated to contribute to HCC pathogenesis in vitro. Our causal analysis suggests an in vivo role through downregulation of tumor suppressors and other mechanisms. CONCLUSION: This meta-analysis describes possible roles of RABL6 and HOXA10 in the pathogenesis of HBV-related HCC. RABL6 and HOXA10 represent potential therapeutic targets and warrant further investigation.

Electrochemical Sensing of Vanillin Based on Fluorine-Doped Reduced Graphene Oxide Decorated with Gold Nanoparticles.

4-hydroxy-3-methoxybenzaldehyde (vanillin) is a biophenol compound that is relatively abundant in the world's most popular flavoring ingredient, natural vanilla. As a powerful antioxidant chemical with beneficial antimicrobial properties, vanillin is not only used as a flavoring agent in food, beverages, perfumery, and pharmaceutical products, it may also be employed as a food-preserving agent, and to fight against yeast and molds. The widespread use of vanilla in major industries warrants the need to develop simple and cost-effective strategies for the quantitative determination of its major component, vanillin. Herein, we explore the applications of a selective and sensitive electrochemical sensor (Au electrodeposited on a fluorine-doped reduced-graphene-oxide-modified glassy-carbon electrode (Au/F-rGO/GCE)) for the detection of vanillin. The electrochemical performance and analytical capabilities of this novel electrochemical sensor were investigated using electrochemical techniques including cyclic voltammetry and differential pulse voltammetry. The excellent sensitivity, selectivity, and reproducibility of the proposed electrochemical sensor may be attributed to the high conductivity and surface area of the formed nanocomposite. The high performance of the sensor developed in the present study was further demonstrated with real-sample analysis.

Sorption of PFOS in 114 Well-Characterized Tropical and Temperate Soils: Application of Multivariate and Artificial Neural Network Analyses.

The influence of soil properties on PFOS sorption are not fully understood, particularly for variable charge soils. PFOS batch sorption isotherms were conducted for 114 temperate and tropical soils from Australia and Fiji, that were well-characterized for their soil properties, including total organic carbon (TOC), anion exchange capacity, and surface charge. In most soils, PFOS sorption isotherms were nonlinear. PFOS sorption distribution coefficients (Kd) ranged from 5 to 229 mL/g (median: 28 mL/g), with 63% of the Fijian soils and 35% of the Australian soils showing Kd values that exceeded the observed median Kd. Multiple linear regression showed that TOC, amorphous aluminum and iron oxides contents, anion exchange capacity, pH, and silt content, jointly explained about 53% of the variance in PFOS Kd in soils. Variable charge soils with net positive surface charges, and moderate to elevated TOC content, generally displayed enhanced PFOS sorption than in temperate or tropical soils with TOC as the only sorbent phase, especially at acidic pH ranges. For the first time, two artificial neural networks were developed to predict the measured PFOS Kd (R2 = 0.80) in the soils. Overall, both TOC and surface charge characteristics of soils are important for describing PFOS sorption.

Beyond 2020: Modelling obesity and diabetes prevalence.

AIMS: To examine and forecast the patterns of diabetes prevalence in synergy with obesity. METHODS: Prophet models were employed to forecast the prevalence of diabetes and obesity in 2030 using time-series data from the WHO Global Health Observatory data repository. K-means clustering models and self-organising maps were used to identify the patterns (clusters) of diabetes prevalence in association with obesity among 183 countries. RESULTS: Three patterns of diabetes prevalence were identified, countries in cluster three were estimated to have the highest obesity (44.9%, 26.2-65.8%) and diabetes prevalence (25.3%, 18.3-32.6%) in 2030. By 2030, countries in the Eastern Mediterranean and Upper-middle-income are projected to have the highest prevalence of diabetes. Overall, Niue is likely to have the biggest impact of diabetes. Liberia is projected to experience the largest rise in the prevalence of diabetes, with over 100% growth from 2014 to 2030. Libya, Kuwait, UK, USA, Argentina, and Nauru are estimated to have the peak prevalence of obesity on their respective continents. There is no decline in the influence of obesity in 185 countries by 2030. Globally, the prevalence of diabetes is projected to increase in 2030. CONCLUSION: These estimates of diabetes prevalence in adults confirm continuity in the "diabetes crisis".

Synthesis and Electrochemical Study of Three-Dimensional Graphene-Based Nanomaterials for Energy Applications.

Graphene is an attractive soft material for various applications due to its unique and exclusive properties. The processing and preservation of 2D graphene at large scales is challenging due to its inherent propensity for layer restacking. Three-dimensional graphene-based nanomaterials (3D-GNMs) preserve their structures while improving processability along with providing enhanced characteristics, which exhibit some notable advantages over 2D graphene. This feature article presents recent trends in the fabrication and characterization of 3D-GNMs toward the study of their morphologies, structures, functional groups, and chemical compositions using scanning electron microscopy, X-ray diffraction, Raman spectroscopy, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy. Owing to the attractive properties of 3D-GNMs, which include high surface areas, porous structures, improved electrical conductivity, high mechanical strength, and robust structures, they have generated tremendous interest for various applications such as energy storage, sensors, and energy conversion. This article summarizes the most recent advances in electrochemical applications of 3D-GNMs, pertaining to energy storage, where they can serve as supercapacitor electrode materials and energy conversion as oxygen reduction reaction catalysts, along with an outlook.

High ErbB3 activating activity in human blood is not due to circulating neuregulin-1 beta.

Neuregulin-1ß (NRG-1) is a membrane-bound or secreted growth and differentiation factor that mediates its action by binding to ErbB receptors. Circulating levels of NRG-1 are characterized by large inter-individual variability with the range of absolute values covering two orders of magnitude, from hundreds to tens of thousands of picograms per milliliter of blood. NRG-1 signaling via ErbB receptors contributes to the cell survival and downregulation of the inflammatory response. A higher level of circulating NRG-1 may indicate increased shedding of membrane-bound NRG-1, which in turn can contribute to better protection against cardiovascular stress or injury. However, it is unknown whether circulating NRG-1 can induce activation of ErbB receptors. In the current study, we performed an analysis of circulating NRG-1 functional activity using a cell-based ELISA measuring phosphorylation of ErbB3 induced by blood plasma obtained from healthy donors. We found high levels of ErbB3 activating activity in human plasma. No correlations were found between the levels of circulating NRG-1 and plasma ErbB3 activating activity. To determine the direct effect of circulating NRG-1, we incubated plasma with neutralizing antibody, which prevented the stimulatory effect of recombinant NRG-1 on activation of ErbB3. No effect of the neutralizing antibody was found on plasma-induced phosphorylation of ErbB3. We also found that a significant portion of circulating NRG-1 is comprised of full-length NRG-1 associated with large extracellular vesicles. Our results demonstrate that circulating NRG-1 does not contribute to plasma-induced ErbB3 activating activity and emphasizes the importance of functional testing of NRG-1 proteins in biological samples.

Ghanaians Might Be at Risk of Excess Dietary Intake of Potassium Based on Food Supply Data.

The World Health Organization (WHO) has highlighted the beneficial role of adequate intake of potassium (K) in combating the global burden of noncommunicable diseases (NCDs), mainly hypertension and cardiovascular diseases. Diets are the main source of K supply to humans and can contribute to both K deficiency (hypokalemia) and excess (hyperkalemia). While global attention is currently devoted to K deficiency, K excess can be even more dangerous and deserves equal attention. The objectives of this paper were to (i) estimate the K intake of Ghanaian population using food supply and food composition data and (ii) compare this estimate with the WHO-recommended requirement for K in order to assess if there is a risk of inadequate or excess K intake. Food supply data (1961-2011) were obtained from the Food Balance Sheet (FBS) of the Food and Agriculture Organization of the United Nations to derive trends in food and K supply. The average food supply in the FBS for 2010 and 2011 was used in assessing the risk of inadequate or excess dietary intake of K. The K content of the food items was obtained from food composition databases. Based on 2010-2011 average data, the K supply per capita per day was approximately 9,086 mg, about 2.6-fold larger than the WHO-recommended level (3,510 mg). The assessment suggests a potentially large risk of excess dietary K supply at both individual and population levels. The results suggest the need for assessing options for managing K excess as part of food security and public health strategies. The results further underscore a need for assessment of the K status of staple food crops and mixed diets, as well as K management in food crop production systems in Ghana.

Ghanaians Might Be at Risk of Inadequate Dietary Intake of Potassium.

Adequate dietary intake of potassium (K) helps fight noncommunicable diseases (NCDs), mainly hypertension and cardiovascular diseases. This paper (i) estimated the K intake of Ghanaian population using food supply and food composition data and (ii) compared this estimate with the WHO recommended requirement for K in order to assess if there is a risk of inadequate K intake. Food supply data (1961-2011) was obtained from the FAO Food Balance Sheet (FBS) to derive trends in food and K supply. The average food supply in the FBS for 2010 and 2011 was used in assessing the risk of inadequate dietary intake of K. The K contents of the food items were obtained from food composition databases. The mean K supply per capita per day was approximately 856 mg. The assessment suggests a potentially large risk of inadequate dietary K supply at both individual and population levels. The results suggest the need for assessing options for managing K deficiency, including assessment of K supplying power of soils and K fertilizer management in food crop production systems, as well as empirical estimates of K content of food items (including those underreported in the FBS) and mixed diets in Ghana.

Chest wall reconstruction after en bloc Pancoast tumour resection with the use of MatrixRib and SILC fixation systems: technical note.

STUDY DESIGN: Technical note. OBJECTIVE: In cases in which partial resection of the rib cage is accomplished with vertebrectomy, reconstruction of the chest wall may be challenging. That is because of lack of the anchor point which normally would be a proximal end of a rib or transverse process. We report a straightforward technique for chest wall reconstruction with the novel use of two systems of fixation commonly applied in spinal practice. METHODS: The operation of a squamous cell carcinoma (Pancoast tumour) of the right lung infiltrating T2, T3 and T4 vertebrae was performed though T4 lateral thoracotomy. Posterior instrumentation with transpedicular screws T1-3-5 on the left and T1-5 on the right side was followed with the right upper lobectomy and hemivertebrectomy. The laminae and facet joints of T2-T4 vertebrae were removed on the side of the tumour. An osteotomy was performed medial to the pedicle at the lateral aspect of the dural sac on the side of the tumour. Proximal parts of four adjacent ribs were removed allowing radical en bloc resection with tumour-free margins. The distal end of each of four rib plates used (MatrixRib Precontoured Plate system) was attached to the proximal end of the rib. The proximal end of the plate was then attached to the rod of posterior fixation construct with the use of a flexible polyethylene terephthalate (PeT) band of the SILC™ fixation system. The other end of the PeT band was then passed through the top-loading clamp subsequently attached to the rod of the posterior fixation. RESULTS: The patient did not require additional procedures for chest wall reconstruction. On the 7-month follow-up, in chest CT he was found with satisfactory expansion of the remaining lung tissue with proper spinal alignment and anatomical shape of the rib cage. CONCLUSIONS: The reported technique can be applied for chest wall reconstruction in cases of total or subtotal vertebrectomy accomplished with the resection extending towards rib cage. It appears to be straightforward, safe and effective allowing good cosmetic and functional outcome.

Age and neo-adjuvant chemotherapy increase the risk of atrial fibrillation following oesophagectomy.

OBJECTIVES: Atrial tachyarrhythmias occur in up to 25% of patients after major thoracic surgery. We examined risk factors for new-onset atrial fibrillation (AF) following oesophagectomy in an attempt to guide prophylactic use of anti-arrhythmic strategies. METHODS: Data were extracted from a database of patients who underwent oesophagectomy between 1991 and 2009. Patients with pre-operative arrhythmias were excluded leaving 997 patients for further analysis. Univariate and multivariate logistic regression analyses were performed to identify factors predicting AF, and receiver operating characteristic curves were generated from a model using these predictors. Statistical significance was reflected in a P-value of <0.05. RESULTS: Patients who developed AF (n = 209; 20.96%) were older (median age 70.54 years vs. 66.9 years; P < 0.01) and included 141 males (67.4%) (P = 0.11). Patients with AF were noted to have a higher in-hospital mortality rate (n = 17; 8.1% vs. n = 34; 4.8%) (P = 0.04) and a longer stay in hospital (14 days vs. 12 days; P < 0.01). Multivariate analysis identified advanced age and neo-adjuvant chemotherapy to be independent predictors of the risk of developing AF. Assessment of discriminative ability of a predictive model revealed a c-statistic of just 0.62. CONCLUSIONS: Despite the identification of age and neo-adjuvant chemotherapy as predictors of AF, the moderate discriminative ability of predictive modelling does not support the use of prophylactic anti-arrhythmic drugs. However, the high incidence of AF after major thoracic surgery makes it necessary to understand its underlying mechanisms better before prophylactic strategies are considered.

Early outcomes of surgery for oesophageal cancer in a thoracic regional unit. Can we maintain training without compromising results?

OBJECTIVES: Meaningful exposure to oesophageal cancer surgery during general thoracic surgical training is restricted to few centres in the United Kingdom. Our Regional Tertiary Unit remains a rare 'large-volume' oesophagectomy centre. We aimed to determine the proportion of patients operated by trainees and their perioperative outcomes. METHODS: From January 2004 to September 2009, 323 patients (229 male and 94 female, median age of 69 (range 40-92) years) underwent oesophagectomy for carcinoma in our Thoracic Surgical Unit. Data were complete and obtained from a prospective departmental database. The preoperative characteristics, operative data and postoperative results were compared between the 120 patients (37%) operated by a trainee (group T) and the remainder 203 patients operated by a consultant (group C). RESULTS: The overall incidence of mortality, anastomotic leak and chylothorax were 6.5%, 5.3% and 2.2%, respectively. There were no differences in terms of age, gender, tumour location, tumour staging, preoperative spirometry or use of neoadjuvant chemotherapy between the two groups. There was no significant difference between the consultant group and the trainee group in the following key outcome measures: postoperative mortality (8% vs 4%), incidence of respiratory complications (30% vs 25%), hospital stay (14 days vs 13 days) and number of lymph nodes excised (median of 16 vs 14). CONCLUSIONS: Training in oesophageal cancer surgery can be provided in a large-volume thoracic surgical unit. It does not seem to compromise outcomes or use of resources.